Asking
The Right Questions
Tips and Suggestions for Psychiatric Interview
for Medical Students
Universiti Malaysia Sarawak Kota Samarahan
Ang Ai Ling
Asking
The Right Questions
Tips and Suggestions for Psychiatric Interview
for Medical Students
© UNIMAS Publisher, 2019
All rights reserved. No part of this publication may be reproduced, stored in retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
Published by UNIMAS Publisher,
Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia.
Printed by
Lee Ming Press Sdn Bhd, No.48, Jalan Ellis, 93300 Kuching, Sarawak, Malaysia.
Perpustakaan Negara Malaysia Cataloguing-in-Publication Data Ang, Ai Ling
Asking The Right Questions : Tips and Suggestions for Psychiatric Interview for Medical Students / Ang Ai Ling.
ISBN 978-967-2298-20-5
1. Interviewing in psychiatry--Miscellanea.
2. Interviewing in psychiatry--Technique.
3. Psychiatry.
4. Government publications--Malaysia.
I. Title.
Dedication
T o my patients-past, present and future.
Indeed, patients are the best teachers.
Ang Ai Ling
Contents
Dedication i
Preface v
Acknowledgement vii
How to use this booklet ix
What this booklet is NOT xi
Setting the scene 1
Room and seating arrangements 3
The psychiatric interview questions 5
Start with open-ended questions 7
You may need to use closed-ended questions sometimes 9 Appropriate use of open-ended and closed-ended questions 11
The 5W1H Questions 13
Asking about the details of incidents or events 15
Asking about psychotic symptoms 17
Asking about Schneiderian first-rank symptoms 23
Asking about hypomanic/ manic symptoms 27
Asking about depressive symptoms 29
Asking about general anxiety symptoms 31
Asking about panic symptoms 33
Asking about agoraphobia 35
iv
Asking about obsessive-compulsive symptoms 37
Asking about post-traumatic stress disorder symptoms 39
Asking about symptoms of dementia 43
Asking about ADHD symptoms 45
Asking about autism spectrum disorder symptoms 49
Asking about alcohol use history 53
Asking about substance misuse history 57
Asking about suicidal ideation 61
Asking about suicidal plan 63
Asking about suicidal attempt 65
Assessing insight 69
References 71
Further reading 72
Preface
T
he idea to develop a booklet on psychiatric interview came from workingwith medical students and identifying their needs for a concise, quick- reference guide on psychiatric interview questions.
Although psychiatric history taking has similar principles and structure as general medical history taking, it focuses on a different range of symptoms and consequently, the questions to be asked.
Basic training in psychiatry varies widely between medical schools worldwide, with the shortest duration being 2 weeks in a 6-year medical program, based on a quick survey among my colleagues and medical students I met from all over the world.
Having received referrals from doctors working in emergency department of remote hospitals who had difficulty to giving sufficient vital psychiatric history such as regarding psychotic symptoms and suicidal ideation, I had to resist the urge to walk them through the whole process of psychiatric interview but it was highly impracticle in the (usually late night) phone consultations.
I could only guide them through the essential questions for immediate management of the patient. It is understandably overwhelming to manage an emergency department in remote hospitals without adequate psychiatric interview skills, and it might prove stressful for the consultant on call who had to make important management decisions based on the information provided by the frontline doctors.
My hope is that this quick-reference guide on psychiatric interview questions may be of benefit to medical students, frontline doctors in remote hospitals and allied health care professionals.
Ang Ai Ling
M.D., Dr.Psych, Fellowship in Child and Adolescent Mental Health June 2019
vii
Acknowledgement
I
thank God for His abundant grace and blessings, without which I wouldnot be able to complete this little project. I am grateful to my family for their patience, support and understanding.
I had the privilege to learn from passionate and experienced clinicians and lecturers at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur;
Hospital Sentosa Kuching, Sarawak; Department of Psychiatry and Mental Health, Sarawak General Hospital; Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Highfield Family and Adolescent Unit, Warneford Hospital, Oxford Health NHS Foundation Trust, UK and Department of Psychiatry, University of Oxford, UK. Through this booklet, I hope to immortalize the wisdom of my teachers.
I would like to thank the former Dean of Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Professor Dr Ahmad Hata Rasit who is currently the Deputy Vice Chancellor (Academic and International of Universiti Malaysia Sarawak) for his support and encouragement for this publication and the staff at UNIMAS Publisher for their assistance and support.
I am grateful to my patients for sharing their innermost thoughts, feelings and experience that enabled me to reflect on what works and what does not in psychiatric interview.
I appreciate my medical students’ input on the aspects they find challenging in psychiatric interview. I hope that this booklet would address their needs and guide their learning.
How to use this booklet
• This booklet comprises of a suggestion of questions to obtain specific information in psychiatric interview and some tips wherever relevant.
• The questions are not organized in a particular order and are meant to be used flexibly, although they generally follow a logical sequence.
• Do not get too hung up on a ‘list’ of questions in your mind that you fail to pay close attention to what the patient is telling you. Practice makes perfect and with adequate practice, the questions will come naturally.
• The questions serve as a guide and are meant to be adapted to the situation and context. The author and publisher accept no legal responsibility or liability for any damage as a direct or indirect result of using this booklet. The users are expected to exercise common sense, empathy and compassion in every interaction, even more so with vulnerable patients.
• The readers are urged to refer to standard psychiatry textbooks for further information on the relevant subject matters.
xi
• A comprehensive reference on psychiatric interview.
» It is designed to be a quick-reference guide. There are many excellent reference books on psychiatric interview already on the market.
(Please refer ‘References’ and ‘Further Reading’ section)
• A substitute for psychiatry textbooks.
» It is impossible to conduct an effective psychiatric interview without an understanding of psychiatric signs and symptoms.
‘The eye sees what the mind knows’
Additionally for psychiatric interview, ‘The ear hears what the mind knows’.
What this booklet is NOT
Setting the scene
• The main purpose of a psychiatric interview is to elicit psychiatric signs and symptoms in order to formulate a diagnosis and to devise a management plan tailored to the patient.
• A psychiatric interview should be therapeutic and therefore be conducted with empathy and sensitivity.
• Always greet the patient.
• Always introduce yourself and request that the patient introduce himself/herself.
• Inform the patient of the purpose of the interview and the estimated duration.
• Inform the patient of the confidentiality of the information they reveal (and make sure you keep your word) and the events in which confidentiality will have to be broken eg. when there is risk to the safety of the patient or others.
• Ask the patient whether he/she is more comfortable to be interviewed alone first, or in the presence of a companion (if they came with a companion).
• Make yourself comfortable and put the patient at ease.
• Be mindful and considerate that the person you are interviewing might be feeling overwhelmed or is experiencing emotional distress.
Setting the scene
Room and seating arrangements
3
• The interview room should be a comfortable and calming space with minimal distractions.
• The traditional seating arrangement in which the patient sits directly across the doctor’s desk is generally not recommended for psychiatric interview.
• The recommended seating arrangement is that the doctor and the patient sit at an angle to each other, at the same height.
This arrangement is less confrontational and allows direct eye contact when necessary.
An example of recommended seating arrangement for psychiatric interview, viewed from top.
